Term
| What are the indications for a chest tube placement? |
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Definition
Drainage of hemothorax or large pleural effusions
Drainage of large pneumothorax
Prophylactic tx of pt with chest trauma
Flail chest segment or severe pulmonary contusion |
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Term
| What are the contraindications for a chest tube placement? |
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Definition
Infection over insertion site
Uncontrolled bleeding |
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Term
| Size of chest tube for adult or teen male? |
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Definition
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Term
| Size of chest tube for adult or teen female? |
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Definition
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Term
| Size of chest tube for a child? |
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Definition
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Term
| Size of chest tube for a newborn? |
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Definition
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Term
| What should you obtain before a chest tube placement? |
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Definition
| Informed consent, pre-procedure x-ray |
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Term
| Where is the skin incision with a chest tube made? |
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Definition
| midaxillary and anterior axillary lines over a rib that is below the intercostal level selected for chest tube insertion (fifth intercostal space - nipple line!!) |
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Term
| Where does the intercostal vessels and nerve path run in the chest? How does this affect the chest tube placement? |
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Definition
| Inferior portion of the ribs; Place chest tube on anterior portion of rib |
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Term
| What areas need to be numbed? |
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Definition
| Infiltrate skin, muscle tissues, and right down to pleura |
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Term
| What blade size do you use to make an incision for a chest tube? How long should the incision be? |
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Definition
| 10 blade (or 11); 4 cm long overlying the rib |
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Term
| What tool should be used to bluntly dissect a tract in the subcutaneous tissue by intermittently advancing the closed instrument and opening it? How far do you carry this blunt dissection to? |
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Definition
| Kelly Clamp; continue until intercostal muscle is reached |
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Term
| After tract is made with a Kelly clamp, what should you do? Why? |
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Definition
| Palpate the tract with a finger; make sure that the tract ends at the upper border of the rib above the skin incision |
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Term
| What can indicate 'entry into pleural space'? |
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Definition
| rush of air or fluid should occur |
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Term
| Once the tract is made all the way into the pleural space, what should be done? Why? |
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Definition
| Use a sterile, gloved finger to appreciate the size of the tract and to feel for lung tissue and possible adhesions |
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Term
| When advancing the chest tube, what direction should it be advanced in? |
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Definition
| continue to advance the chest tube posteriorly and superiorly |
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Term
| Before securing the chest tube in place, what should you look for? Why? |
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Definition
| look for a respiration-related swing in the fluid level of the water seal device to confirm correct intrathoracic placement |
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Term
| What type of suture material should be used to secure the chest tube? What type of stitch should be used? |
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Definition
| 0 or 1-0 silk or nylon suture is used to secure the chest tube to the skin, central vertical mattress stitch with ends left long and knotted together can be placed to allow for sealing of the tract once the chest tube is removed. |
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Term
| What gauze should be placed directly around chest tube and skin incision? |
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Definition
| Petrolatum (Vaseline) gauze |
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Term
| How should the emerging chest tube be secured? Why? |
|
Definition
Strap the emerging chest tube on to the lower trunk with a "mesentry" fold of adhesive tape
avoids kinking of the tube as it passes through the chest wall. It also helps reduce wound site pain and discomfort for the patient |
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Term
| How can you prevent puncturing the spleen or liver? |
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Definition
| Make sure to insert between 5th and 4th ribs (nipple line |
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Term
| What is the purpose of arthrocentesis? |
|
Definition
| Aspiration of a joint for diagnostic and/or therapeutic reasons |
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Term
| What are the indications for arthrocentesis? |
|
Definition
undiagnosed mono- or poly-arthritis with an effusion
suspected infection
suspected crystalline arthritis
joint effusion after trauma |
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Term
| What are the contraindications of arthrocentesis? |
|
Definition
Overlying cellulitis, wound, bacteremia
Suspected infected joints should not be given steroid injections
Neuropathic joint (Charcot joint)
Coagulopathies
Uncontrolled DM
Prosthetic joints
Inaccessible joints |
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Term
| How many injections can be given in a year? |
|
Definition
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Term
| What are the reasons for injecting a joint? |
|
Definition
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|
Term
| What are the indications for injections? |
|
Definition
Osteoarthritis
RA
Gouty arthritis
Synovitis
Bursitis
Tendonitis
Muscle Trigger points
Carpal Tunnel Syndrome |
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|
Term
| What are the contraindications to injections? |
|
Definition
Adjacent osteomyelitis
Bactaremia
Hemarthrosis
Impending joint replacement surgery
Infectious arthritis
Joint prosthesis
Osteochondral fx
Periarticular cellulitis
Poorly controlled DM
Uncontrolled bleeding d/o |
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Term
| After a joint injection, how long should the pt avoid strenuous activity? |
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Definition
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|
Term
| What are the local SE of a joint injection? |
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Definition
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Term
| At what location should you inject a knee? |
|
Definition
| Mark 1 fingerbreadth above + lateral to the superior-lateral of patella |
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|
Term
| What are the rotator cuff muscles? |
|
Definition
Supraspinatus
Infraspinatus
teres minor
Subscapularis |
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|
Term
| What is the proper location for a glenohumeral injection? |
|
Definition
| sulcus between head of humerus and acromion |
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|
Term
| What is the proper location for an AC joint injection? |
|
Definition
| At slight depression where clavicle meets acromion |
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|
Term
| What is the proper location for a sub-acromial injection? |
|
Definition
| Insert inferior to acromion at lateral shoulder |
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|
Term
| How effective is an elbow epicondyle injection? |
|
Definition
| very effective in the short-term, but does not last longer than 6 weeks |
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